Assuming HIV is the cause of AIDS (and assuming the CDC didn't botch the HIV=AIDS definition), then what is the cause of HIV-Negative AIDS (idiopathic CD4 lymphocytopenia)?

Response from Dr. Frascino

Hello,

"Idiopathic" by definition means the disease has no known cause. If it did, it would no longer be idiopathic! What we do know about idiopathic CD4 lymphocytopenia (ICL) is that it's not caused by an infectious or transmissible agent. I'll reprint a question from the archives that discusses ICL.

Dr. Bob

THIS IS NOT IN THE ARCHIVES!! Nov 17, 2005

Youve ignored this before and im asking again because i know its not in the archives. Simple question! Can someone have symptoms of HIV infection and then develop ICL? or is ICL independent of HIV like symptoms?

Response from Dr. Frascino

Hello,

O.K., here's the scoop on what we know about Idiopathic CD4 Lymphocytopenia (ICL). By definition, it's a syndrome characterized by low CD4 counts (less than 300) that are not caused by HIV or other medical conditions (Sjogrens Syndrome, Sarcoid, Radiation therapy, atopic dermatitis, steroid therapy or lymphoma).
Transient unexplained decreases in CD4s can occur in healthy folks. Several important observations have been made about ICL:

1. There is no evidence it is caused by an infectious agent, as there is no clustering or evidence of spread from contact evaluations.

2. The most common opportunistic infections associated with ICL are cryptococcosis, molluscum and histoplasmosis. In general, folks with ICL have fewer OIs than HIV/AIDS patients for any given CD4 level. Infections, such as PCP, Candida and KS (HHV-8), are unusual for ICL.

3. ICL patients generally have a relatively good prognosis and their CD4 counts remain stable.

Presently ICL is being treated with IL-2 and gamma interferon, but since cases are relatively rare, treatment experience is limited. Cases of ICL should be reported to local and/or state health departments for follow-up.

That may be more information than you or our readers wanted to know, but at least you won't accuse me of ignoring you any longer, right?

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